Tuesday, December 27, 2011

This post is in honor of the two best doctors in America, and possibly the world.

While their names aren't known to the general public, they're instantly recognizable to all of us in the medical profession. And, in spite of their amazing talents, neither has ever been recognized by any of the various "Best Doc" magazines published in different cities.

So I feel that, after years of them laboring in secret, it's time to honor them.

AND THE 2 BEST DOCTORS ON THE PLANET ARE:

Some Guy, M.D. and This Lady, M.D.

And here is why they so richly deserve this honor:

1. Accessibility.

I don't know either of them personally. In fact, they have no phone listing. Yet, they're far more accessible than any other doctor I know. While I only see people in my office, or the hospital, during certain hours, Drs. Guy and Lady are accessible anywhere, anytime. Patients tell me they run into them at grocery stores, beauty salons, amusement parks, laundromats, hardware stores, cocktail parties- anywhere.

I might get a little irritated (okay, a lot irritated) if patients were to corner me for a consultation while I was out with my family, but not Some Guy or This Lady! In fact, from what I've been told, they don't mind at all, and often initiate the discussions themselves!

2. Cost.

This is how I make a living. I like this job, but it's still my job. I have a family to support. So Mary has to make sure we take your insurance, collect your co-pay, etc.

But not Drs. Guy and Lady! They don't check those minor details before providing treatment! As best I can tell, they don't charge anything for their time and advice.

3. Sheer brilliance.

I, and most doctors, do physical exams and order tests. They may vary from a few labs to an MRI, but generally that's how we get an idea of what's going on, and what the best course of action will be. Not Some Guy or This Lady, though!

They appear to have an uncanny knowledge of EXACTLY what's going on with you, even though they never touch you, ask detailed questions, or order any studies whatsoever! I can only assume they must always be right, as my brief search of American medical board records showed that neither of them has ever been subject to a single complaint or lawsuit!

4. Treatments

I prescribe medications. Some are cheap, some hideously expensive. But I do it to help you.

But Drs. Guy and Lady apparently have knowledge of treatments beyond the medical realm, which they generously share free of charge, involving a number of simple over-the-counter remedies that can apparently cure anything.

5. Knowledge.

I'm a specialist. I know a lot about common things in my fields, less about rarer disorders, and only a little bit about other fields. I think most other specialists would say the same.

But this amazing pair knows about EVERYTHING. They are general practitioners extraordinaire, with a knowledge fund that puts even the greatest doctors, like Osler, Charcot, or (my personal idol) Oscar London, to shame.

I can only assume this tremendous knowledge has come from experience. Some diseases are so rare that many of us go through an entire career without seeing them, but these two have seen ALL OF IT! They have incredible connections that have led to this (usually involving their uncle's friend's second cousin's wife, who once met a lady who's sister might have had the rare disorder).

6. Trust.

There's this mysterious thing called the Doctor-Patient relationship. It involves trust, and can take a while to build. There's some chemistry in it, and conversation, and voodoo. But it's critical to helping people.

But while it can take 1 or more appointments for most doctors and patients to reach this stage, for these two it's amazingly instantaneous. Most patients who get advice from them trust them automatically and completely, and are quite confident in their diagnostic and treatment abilities. This is in spite of (or perhaps because) they don't appear to have the same, years-long, formal medical training that I and my colleagues do.

7. International reputation.

I only practice in Grumpyville, and only have one medical license. But these 2 apparently are somehow EVERWHERE. I've had patients run into them in all 50 states, and even on overseas trips. Quite frankly, hearing about them makes me embarrassed to only be able to cover 1 hospital.

So, as 2011 comes to a close, I salute these 2 giants of medicine, and their numerous contributions to patient care.

I'd like to thank Brent for sending this in. It's from a cardiologist's dictation done with Dragon, that was mailed without being proofread.

While I can understand what the doctor is trying to say, this just sounds bad, and makes him look sloppy. And the little "This dictation was done with voice recognition software and may contain errors and omissions" disclaimer (that everyone puts at the bottom these days) is just a fancy way of saying you're too damn lazy to proofread.

"Concerning symptoms are note above and the patient, who by history sounds like she has had brief episodes of PSVT. All his life. I would like to obtain an echocardiogram and if this is unremarkable. A stress echo to start her duration of the above. If these are unremarkable. We will obtain an event monitor.

He is instructed that he is not to drive a lesser correctable etiology of these spells can be found or if he does not have them for 6 months. As also instructed not to be in a situation where she has a spell. He didn't injure himself, such as being a ladder."

Sunday, December 25, 2011

Today we celebrate the birthday of one of the most remarkable people in recorded history.

Sir Isaac Newton

At the age 25, he published the Principia, which laid out the laws of force, motion, and gravity. He went on to invent calculus, showed that light is made up of a spectrum of colors, and made significant advances in optics. Although others would likely have discovered these at some point, it’s truly remarkable that one incredible intellect did so much.

Therefore, Sir Isaac, in honor of your 369th birthday, I dedicate this. Without you, it couldn't have been written. And I imagine it would be even better if all the exoplanets were known when it was.

Saturday, December 24, 2011

It was Christmas Eve. The most horrible war the world had ever known was slowly drawing to a close. Nazi Germany would collapse in 6 months, the Japanese Empire in 9.

But Hitler's last large offensive, the Battle of the Bulge, was raging, and the Allies desperately needed reinforcements to stop it. Troopships were frantically bringing soldiers across the English Channel.

And on Christmas Eve, 1944, the passenger liner Leopoldville was chugging 2,235 soldiers over to reinforce the army's 66th Infantry. She was escorted by 4 destroyers.

It was a stormy night, and winds reached sea force 6. Many of the troops became seasick, and spent the night in the bathrooms or bed.

German U-Boats were still fighting, and on that night U-486, under the command of Oberleutnant Gerhard Meyer, was prowling the area. He found an opening in the destroyer screen and put a torpedo into the Leopoldville, with devastating results.

Troop compartments G-4 and F-4 contained 355 soldiers. When the torpedo exploded, F deck collapsed into G, and destroyed all stairways out. Less then 20 men from these 2 compartments were ever seen again.

Curiously, in spite of the damage sustained, no order to abandon ship came for some time, leading many to assume it was safe to go back to bed. And when the order did come on the P.A. system, it was in Flemish, and wasn't translated for the soldiers.

The crew of the sinking ship knew the extent of the damage. They quietly gathered their belongings (including a parrot), loaded them into lifeboats, and departed. They didn't warn the troops they were carrying, and left no one behind who knew how to work the lifeboats.

The Leopoldville had a good chance of surviving if she could be beached, and calls went out for tugs to pull her the last 5 miles to land. But it was Christmas Eve. Many on shore were on leave, and didn't take the first warnings seriously. Officers at parties had left orders that they were not to be interrupted.

A few miles from port a disaster was happening. And when the first cries for help came (30 minutes after the explosion), it was from one of the destroyers attending the sinking liner- Captain Limbor of the Leopoldville (who went down with the ship) refused to send a distress signal.

One of the catalysts to saving lives was Lt. Colonel McConnell on shore. On his own authority he cursed, kicked, and pulled men out of bed and parties, and brought life to the dockyard to send help. 50 minutes after the explosion the first rescue ships left Cherbourg, but critical time had already passed.

In Cherbourg Lt. Commander Davis mustered whatever he could - 3 PT boats - and sent them racing to help. He sent staff into town to pull men out of bars and restaurants and get them back to their ships. He notified hospitals, hotels, and camps that emergency facilities and quarters would be needed.

Commander Pringle of the destroyer H.M.S. Brilliant took the gutsy step of bringing his little ship alongside the dying giant. As their hulls kept crashing together in the waves, Brilliant began leaking herself. But Pringle ordered his engineers to stay at the pumps and keep working. British sailors yelled up at the Leopoldville for their American allies to jump across in the rocky seas, and did their best to assist them in getting abroad. Comically, the other 3 destroyers hadn't been informed of the Leopoldville's damage, and after giving up the hunt for the U-Boat they went ahead into port.

After collecting 700 soldiers, Brilliant had to cut free to repair her own hull damage. Pringle had heard of the approaching PT boats and tugs, and planned to get into port, unload the survivors, and return to help. But the Leopoldville didn't have that much time.

Many died bravely that night. With the stairs gone, Colonel Ira Rumberg had himself lowered repeatedly into the ship's hold, bringing up a man under each arm every time. He went down with the ship, trying to save more. He was just one of many others who died when they willingly went below decks to lead others to safety.

The Leopoldville finally sank at 8:30 p.m., 2 1/2 hours after the torpedo struck. She left an estimated 1000 men floating in the stormy, 48°F (9°C), sea, many of whom died of exposure over the next few hours. The crews of an assortment of military and private craft worked through the night trying to save as many as possible.

The tragedy of the Leopoldville is that, outside of those who died in the initial explosion, all could have been saved if the ship's crew had been properly organized, distress signals sent out as soon as the damage became apparent, and the majority of the shore authorities weren't in a state of negligence. 802 men died that night- the only American ship with more casualties during WWII was the U.S.S. Arizona.

The U-486 with Oberleutnant Meyer and his crew themselves were all lost 4 months later when they were sunk by the submarine H.M.S. Tapir.

Sadly, the allied governments decided to cover up the sinking. Families were told their loved ones were dead or missing, without disclosure of circumstances. The files weren't declassified until 1996, more than 50 years after the disaster. So memories and memorials of the disaster are few.

Today the Leopoldville is a war grave, lying on her side at the bottom of the English Channel.

This is the last installment of the 2011 gift guide. Thanks to all who sent stuff in, and remember to please keep sending them year-round. Before you know it the 2012 gift guide season will be here!

Featured gift #1

Ladies, are you tired of routine breastwear (is that a word)? Are you hopelessly addicted to playing Angry Birds?

Well now you can liven up your chest, and show your love of video games, with the Angry Boobs bra!

Yes, this once-in-a-lifetime bra is available from Etsy in sizes from 34A to 38DD. It does not inflate with wine, though consumption of beer by males may make it appear to do so.

Featured gift #2

In this era of trying to use clean, renewable, energy sources, it's nice to see a product that takes this to the point of idiocy:

Yes, folks, it's the solar-powered windmill!

This amazing product has unlimited potential: By harnessing the power of the sun, you can make a windmill turn! Then, by using the electricity generated by the windmill turning, you can power a lightbulb! And you can use the lightbulb to power the solar cell! Voilá! You've discovered a feedback loop with an endless energy supply!

Do you wish you could take your dog everywhere? Have you ever heard the expression "putting on the dog" and wanted to do it? Well, now you can!

Yes, with Woofspun products you can order quality knitted items made from genuine dog fur, or even collect your own from a favorite pet (or 2, or 3) and they'll turn it into yarn for you!

Given that 2 of the Grumpy dogs are less than 20 pounds, I doubt they give off enough in a lifetime to make a decent pair of gloves. Although if Mello doesn't stop pulling food off the counter and eating it (including a tub of artichoke & olive hummus, FFS!) she's going to be a rug pretty soon.

Men like breasts and women like wine. So what could be a better compromise than this?

According to it's web site the Wine Rack will increase an A cup to a DD, and holds 750ml of your favorite Cabernet (or whatever you prefer), with a discreet sipping tube. And you can inflate it with air after depleting the wine, to keep things looking "as advertised."

Saturday, December 17, 2011

Last night was that annual rite of parental torture, the Wingnut Elementary School band holiday concert.

My kids like playing in the school band, so, as supportive parents, we pay the instrument rental fees, put up with their unearthly screeching practice sessions in the living room, and attend the 2 annual concerts.

Elementary school band concerts are never a blast. They're held in the school cafeteria, meaning you have to sit at long lunch tables designed to be partially comfortable only for people half your size.

The kids really do try (at least most of them) but are still often out of sync and flat. And then there's the music selection. After the first 2 numbers all the songs start to sound A LOT alike. And they all sound like "Hot Cross Buns," which you've already heard played in your home so many times that you want to barf.

These things last about an hour, but seem like much longer. You sit there, politely clapping after each number, and hope your kids don't notice that you've dozed off or started playing Angry Birds.

As veterans, Mrs. Grumpy and I came well prepared. We sat in a far row where our kids couldn't see if we were playing scrabble doing medical research on our iPhones, and brought some Diet Cokes. You can always tell which parents are first timers, because they sit in the first row and bring cameras.

But this year, we had an unexpected reprieve.

At 18 minutes into the performance, during "Good King Wenceslas" a kid playing oboe abruptly projectile vomited into the first row, showering a group of eager parents with a partially digested Happy Meal. The other band members stopped, then valiantly tried to restart for a few seconds, but were so horribly out of sync as they tried to both read music and watch the new entertainment that it was a lost cause. Barf Guy's mom heroically leaped onto the stage and tried to use her husband's sweater (fortunately with him out of it) to clean it up. Then the kid heaved some more.

After about 30 seconds the band teacher politely said "Thank you all for coming, and Happy Holidays. Is the janitor still here?"

I feel sorry for this kid. Because from now on until he moves away to college he'll be known not as Mike or Steve or Mason, but simply as "the kid who puked during the holiday concert."

Friday, December 16, 2011

But a Japanese company is hoping that's high on somebody's list. They've developed a teddy bear sleep apnea robot.

It puts a cuddly-looking oxygen sensor on your finger, and if it hears you snoring, or detects your oxygen level dropping, it reaches up with a mechanical paw and wacks your face to make you turn your head.

Here's an informative video:

Personally, I have to say that if I was asleep and this thing grabbed my face, I'd likely shit the bed. So unless the robot is going to clean that up, too, I don't want one.

To me the highlight of the story is that employees called police after noticing she was acting weird. Given what I've seen on my rare trips to WalMart, I'm somewhat reassured to know that they actually do have a cut-off point.

So last night Mrs. Grumpy and I sat outside on our freezing cold patio to have the "what are we getting the pet rats children for Christmakuh?" talk.

While sitting there we suddenly heard this LOUD crunching and rattling noise, which kept getting louder and louder. As we watched, one of Frank's remote-controlled cars (which makes more noise than a garbage truck) came rolling slowly around the hot-tub. With a running digital voice recorder duct-taped to the roof.

I have to give Frank points for innovation, but a "FAIL" for execution. If you're going to spy with a remote-controlled toy, use one that doesn't sound like a garbage disposal.

Saturday, December 10, 2011

For whatever reason, someone (who I assume hasn't been taking their medications) sent me a long rambling diatribe about how much they hate doctors. Specifically, the phrase "rich doctors and their fancy cars" was used several times in the rant.

Therefore, in the interest of full disclosure, I hereby list all of the cars that Dr. Grumpy has ever owned:

Friday, December 9, 2011

It's the middle of the night, and you're using the bathroom. But after sitting down you discover there's either a power outage or the bulb burned out. How often does this happen to you? That many? Have you considered calling an electrician?

Anyway, if this is something a friend of yours deals with regularly, than I have the perfect gift for them: glow-in-the-dark toilet paper!

This miracle is also useful for camping or as an emergency flashlight.

All right, for those of you who are too busy to keep up on breaking medical research that affects our lives, here's a big one:

The Center for Disease Control publishes a weekly report summarizing disease trends. In this week's, among generic items about flu and arthritis, was a case of Campylobacter jejuni (it's a bacterium) infection in 2 sheep-ranch hands in Wyoming.

Normally this bug is spread by contaminated food. But the 2 guys involved hadn't clearly eaten anything known to be an infectious source.

So, after diligent detective work the CDC found this pair had contracted it by castrating lambs.

WITH THEIR TEETH.

Yes, folks. These guys were actually biting off lamb balls. While this was a way of detesticulating sheep back before the germ theory was popular, it's generally fallen out of use.

Except, apparently, for 2 guys in Wyoming.

So, to summarize:

1. Animals carry diseases.

2. When neutering livestock, do not use your teeth as a surgical instrument.

3. Be careful who you kiss on a Wyoming sheep ranch, as you don't know where their mouth has been.

Thursday, December 8, 2011

I've always liked the Muppets. One of my favorite songs is "Rainbow Connection," as performed by Kermit at the beginning of their first movie.

For those of you who don't know it:

Anyway, it may be corny, but the song got me through some shitty times. After I failed the first anatomy test in medical school (big time, too- I was the class low out of 120 people) I went to a used record store and bought the Muppet Movie soundtrack just to listen to that song. In a sappy sort of way it reminded me of why I was there in the first place, and I pulled my shit together, didn't drop out of school, and forged ahead.

Life goes on. Medicine is still fun. I mean, I like what I do. I have to earn a living, so I might as well be doing something I like.

And then, one day a few years back, I was having an ordinary day at the office. And toward the end of it was served with my first malpractice suit.

Nothing will kick the shit out of you faster than that moment. Yes medical students and residents, you WILL get sued. Get used to it. Someone on Sermo recently wrote "I have believed for a long time that unless you are practicing grossly negligent medicine your probability of getting sued is small." This is a remarkably ignorant statement.

Getting sued is like cancer- something that happens to other people. I think all doctors, on a superficial level, know it will likely happen. But you're still blindsided when it happens to you.

Obviously, I'm not going to go into legal details of the case, or who won, or even if it was dismissed. Because none of those are relevant to this post.

And I'm sure there are plenty of patients out there who can write how horrible Dr. Butcher maimed you. I'm sure some of you have legitimate claims. But I'm not writing about you.

Malpractice isn't black or white. It's really mostly shades of gray. I'm not biased against lawyers, in fact- my Dad is one, and sued several doctors for malpractice. But I'm not going to get involved in arguments about lawyers vs. doctors, either.

My point is just my own experience.

People portray doctors as being arrogant or uncaring. And I'm sure some are. But anytime a case goes bad, it's personally devastating for most of us. Even if you did nothing wrong. Sometimes shit happens despite your best efforts.

It hurts. A lot. You do your best day in and day out, and feel awful when things go wrong. And now someone is accusing you of having committed malpractice in your efforts. They tell you not to take it personally, but how can you not? Hell, they even name your spouse in the suit (really, they do).

You see, there is always another doctor out there willing to testify in court (for a nice fee, of course) that what you did wasn't appropriate. He's Dr. Jukebox. You put in money and he'll play whatever tune they want him to (it pays a lot better than seeing patients). The statements from these whores will make you feel like shit, and the legal language used makes you sound on a par with Dr. Mengele.

No amount of medical competence can prevent someone from filing a lawsuit against you. Even if you did nothing wrong, there's always a hungry lawyer willing to take the case. After all, it only costs about $100 to file a suit, the potential payoff is 1/3 of the winnings, and he knows a Dr. Jukebox who will gladly testify that you're incompetent.

Your medical school teachers won't tell you what it's like to be sued, but I will.

It's devastating.

It kicks the shit out of you. You lie awake at night wondering if you're going to lose everything you ever worked for. You cry. You think about suicide, but have to go on for your family. With this sword of Damocles hanging over your head, you still have to go to work every day, and do your best for the patients who still depend on you. Some days it's pretty damn hard NOT to start drinking.

And, deep down, you wonder: Am I really incompetent? You question your own judgment. Suddenly every headache patient needs a brain MRI. Every person you see is a time bomb. You start to view them as the enemy.

People use the phrase "defensive medicine" in a derogatory fashion, meaning unnecessary testing doctors order to prevent themselves from being sued. But after it's happened to you, hell, you don't give a fuck how much money the "unnecessary" tests cost. You'll order anything to cover your ass.

And no matter what you did, Dr. Jukebox will testify that it wasn't the right thing. And no amount of literature in your favor will change his "expert" (i.e. well-paid) opinion. The people on the jury deciding your fate aren't medical people.

Even if you win, it still doesn't take away the living hell you and your family are put through for the 3-5 years (yes, years) it takes the case to play out. The sleepless nights, the gray hairs, the stress eating that shortens your time on Earth, and the spouse and kids who worry about you.

And, regardless of the case's outcome, it will forever destroy your Rainbow Connection, and the beliefs that once drove you to dream of being a doctor.

We all love ice cream cones, but they're a HUGE hassle. I mean, you have to turn and lick them on all sides, otherwise they drip down and get messy. And this is SUCH A BIG PROBLEM that it hardly seems worth the effort to have a cone.

But not any more!

This remarkable product continues the worldwide trend of eating more calories while expending as few as possible, so someday you too can look like the people in WALL-E. You may now experience the ultimate in human laziness, and never worry about getting ice cream on your sneakers again.

Sunday, December 4, 2011

This morning, while on rounds, I dialed in to the hospital system to dictate a consult. I was stunned to be told that my privileges had been suspended for delinquent medical records.

This was a shock, as I treat medical records with an obsession. Every Thursday I stop by medical records and ask if there's anything for me to sign. For the last 6 weeks the girl there has politely checked her computer, then said "Nope, thank you for checking".

So I promptly marched down there:

Dr. Grumpy: "Excuse me, do I have anything to sign today?"

Ms. Helpful: (looking at her computer) "Um, nope. Thank you for checking."

Dr. Grumpy: "Well, when I dialed in, it says I've been suspended for medical records delinquency."

Ms. Helpful: "That's correct. You have over 60 charts to complete, 28 of which are delinquent"

Dr. Grumpy: "WHAT!!! Then why didn't you tell me that?!!"

Ms. Helpful: "You only asked me if you had anything to sign. You have nothing to sign. We are all electronic records now. You don't actually sign anything."

Dr. Grumpy (in shock): "Okay... So how do I complete my records?"

Ms. Helpful: "You have to log into the e-Chart system."

Dr. Grumpy: "No one told me we'd completely switched to e-Charts, or that I had records to complete. How was I supposed to know this?"

Ms. Helpful: "Because the first time you sign in to e-Charts it tells you that".

Saturday, December 3, 2011

Were you a perfectly straight heterosexual until you learned to drive, and then, upon getting your license, immediately developed an uncontrollable attraction for your own sex and switched to the other team?

Did you find that handling the steering wheel all-by-yourself made you want to start wildly screwing everything in site and use porn (I think I did, but it likely had more to do with 16 year-old-boy-hormones than my 1978 Datsun 810 station wagon).

In a stunning discovery, the highest religious council of Saudi Arabia has actually discovered these "facts," with a new report warning that if Saudi woman are allowed to drive the population will turn to homosexuality, prostitution, and pornography. It also noted that within 10 years of the ban being lifted, the nation would completely run out of virgins (REALLY!).

Thursday, December 1, 2011

It's December 1, the Christmakuh/Kwanzaa/Solstice/Festivus season is upon us, and it's time to roll out the annual holiday gift guide. As always, we at Grumpy Neurology, P.C. scour the internet and catalogs year-round so you don't have to!

In the past I've focused on gifts for humans, but since dogs are a big part of our families, I thought I'd kick off this year with something for them. And what better gift for a furry friend than his own sex doll?

(click to enlarge, if you're into that sort of thing)

Yes, the HotDoll doggy love toy is available in 2 sizes (looks like small and medium from the site, I don't see anything for a Great Dane), and is "made to be easily distinguished by dog’s eyes."

It also notes that "the pink hole needs to be washed regularly for hygienic reasons," a job which will likely spark more family fights than "whose turn is it to pick up the dog poop?"

I can just see this being marketed with The Rolling Stones belting out a modified version of one of their classics:

"Hey! You! Get off of my leg!Don't hang around, or sit up and beg!"

The site doesn't say if there are other models that require batteries, but quite frankly I don't want to know.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

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Dr. Grumpy is for hire! Need an article written (humorous, medical, or otherwise) or want to commission a genuine Grumpy piece for your newspaper/magazine/toilet paper roll? Contact me to discuss subjects. You can reach me at the email address below.

Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.